Report Summaries
Food systems and how they relate tomalnutrition in low- and middleincome countries
This is a summary of the following report:
ENN (2021) Food systems and how they relate to malnutrition
in low- and middle-income countries. Oxford, UK.
https://www.ennonline.net/foodsystemsscopingbriefT

he year 2021 was a critical year
for nutrition with issues aroundfood systems taking centre stage
following the UN Food Systems
Summit in September. This summit, and thesubsequent momentum generated, presented a unique opportunity to transformfood systems so that they work to reduce
malnutrition in low- and middle-income
countries (LMICs). Nevertheless, it is notalways immediately clear how food systems
are related to malnutrition in all settings
and actors working in malnutrition reduction do not always know how best to contribute to food systems conversations.
ENN developed this brief to help thenutrition community to contribute to conversations on food systems transformationand to capitalise on the opportunities offeredto drive forward actions to reduce malnutrition in LMICs. The brief summarises therelevant aspects of food systems and suggests
key entry points for engagement. The authors
conducted a scoping review of the literatureand key informant interviews and foundthat today’s food systems are broken andare unable to deliver nutritious, safe, affordable and sustainable diets. Instead, such systems actually undermine nutrition in several
ways, particularly for vulnerable and marginalised populations.
The key pressures on food systems thatare leading to suboptimal function and ultimately to poor global diets include agricultural
production becoming increasingly dependent
on a small number of intensified monocultures which does not match global nutritional
needs, climate change influencing the quality
and quantity of food that can be produced
and our ability to distribute it equitably,
population growth, urbanisation and globalisation which are resulting in longer
supply chains, more processing and thegreater availability of ultra-processed foods
and consumer behaviours being heavily influenced by the unregulated marketing campaigns of transnational companies.
The report highlights the effects of foodsystems on nutrition in fragile environments,
the relevance of food systems for infant andyoung child feeding (IYCF), the relevanceof food systems for the nutrition of school-86

aged children and adolescents and the effectof food systems on the prevention and treatment of wasting and stunting. For example,
in-kind food assistance, a life-saving solution
in fragile contexts, has not been successful
in rebuilding and strengthening food systems.
It is increasingly recognised that multisector development actions need to be combined with humanitarian aid in fragile contexts, such as actions across agriculturalproduction, market and trade systems, foodprocessing and retail, as well as actions toimprove consumer demand and purchasing
power. Examples of food systems interventions influencing IYCF include the regulationof trade and the promotion of breastfeeding
substitutes, policies around maternity leave
for working mothers, investment in breastmilk bank infrastructures, interventions toincrease public knowledge of optimal IYCF
practices, the regulation of commerciallyavailable baby foods and nutrition-sensitive
agriculture and livestock interventions for
improving access to healthy complementary
foods in farming communities. Adolescentsand children are especially susceptible tothe power of marketing by large food corporations due to the current lack of regulation. School food systems are an important
entry point for influencing diets in schoolaged children. Lastly, the report discusses
the system surrounding the provision ofready-to-use therapeutic food for children
with wasting which is a microcosm of wider
food systems and needs a similar transformations such as shorter supply chains,cohesive but efficient product regulationand investment in national infrastructure.
The report concludes that, although there
is a plethora of existing food systems knowledge and evidence within the areas of nutrition
mentioned above, these topics are often not
articulated together. The evidence-base regarding the impact of interventions withinfood systems on nutrition is vast but also
complicated and somewhat disorganised
which can make it difficult for policy-makers,
donors and practitioners to navigate. Thereis a need to identify and translate relevant
evidence of food systems interventions for
improving undernutrition in LMICs since
the links here are not always directly apparent
and discussions can often be siloed.

FIELD EXCHANGE ISSUE 67, Apr 2022 www.ennonline.net/fex

A self-monitoring tool
to improve nutrition
counselling inCambodia
This is a summary of the following papers:
Sigh S & Sacher A (2021) The use of a selfmonitoring tool improves nutrition counsellingdelivered by community volunteers inCambodia. Action Against Hunger Cambodia;
and Sigh S (2020) The use of a self-assessment
tool in care groups to promote behaviour change,
increase self-confidence and perceived control ofwomen, and assess individual behaviour adoption
over time. Action Against Hunger Cambodia.

To promote optimal child and maternal careand nutrition practices, the Multisectoral
Food and Nutrition Security (MUSEFO)
project implemented by Action Against
Hunger implemented care groups in 180 villages
across the Kampot and Kompong Thom provincesin Cambodia. The care group approach is a community-driven behaviour change model that combines
cascaded, repeated messaging with comprehensive
coverage to elicit nutrition- and health-related behaviour change. The groups are formed of female
health volunteers who conduct regular group sessions
and counselling with 10-15 caregivers of children
under two years of age from their neighbourhood.
These papers evaluate the added value of using aself-monitoring tool – an illustrated card given to
the caregiver to monitor practices at home – andparticipatory learning methods in addition to theexisting delivery model, using mixed-methods: adesk review, telephone and in-person interviews,
focus group discussions, and secondary data analysis.
In June 2020, 26 interviews and focus group discussions were conducted with 108 respondents anddata from 30 self-monitoring cards. Both volunteers
and caregivers perceived the card and participatory
method as useful, noting that it acts as an aid thatguides conversations during home visits, focusing
the nutrition and health counselling on relevant
priorities. Volunteers felt more confident when providing counselling which should result in increased
job satisfaction. Feedback indicated that the tool enabled caregivers to participate actively in conversations.
In addition, keeping the card at home made it easierfor caregivers to recall key recommendations with
one caregiver noting that “having this card is likehaving a teacher who keeps reminding me at home”.
Despite some challenges, e.g., illiteracy and incomplete or lost cards, the findings of this pilot
study suggest that the combination of the selfmonitoring tool and participatory methods is apromising approach to improving nutrition counselling quality and move beyond dissemination ofnutrition information alone.